Basic Information
| Provider Information | |||||||||
| NPI: | 1164894200 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPECIALTY IMAGING | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RESILIENCE IMAGING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8610 EXPLORER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7199554332 | ||||||||
| FaxNumber: | 7199554148 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 INVERNESS DR E | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801125118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037570332 | ||||||||
| FaxNumber: | 3037570558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2015 | ||||||||
| LastUpdateDate: | 06/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7199554332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.